Type of publication:
Conference abstract

Author(s):
Cook M.; *Allos B.; O'Beirn M.; Jegannathen A.; Denley S.; Homer K.; Sabel L.; *Chatterjee A.; Koh P.

Citation:
Lung Cancer; Jan 2017; vol. 103, Supplement 1, Page S12

Abstract:
Introduction: 10-20% of patients presenting with NSCLC have synchronous brain metastases, conferring a 4.8 month median survival. Recently published QUARTZ trial data challenges the use of whole brain radiotherapy (WBRT) in older inoperable patients. We present a multicentre retrospective review of the management and survival outcomes of newly diagnosed NSCLC patients with synchronous brain metastases in the Greater Midlands. Methods: Patients diagnosed with NSCLC and synchronous brain metastases January 2014 to June 2015 were identified from five regional hospital lung multidisciplinary meetings. Data collected included patient demographics, performance status (PS), staging, histology, number/volume of brain metastases, initial management, subsequent therapeutic strategy and outcomes. Results: Of 758 newly presenting metastatic lung cancer patients identified, 51(6.7%) had biopsy-proven NSCLC and brain metastases, with demographic, diagnostic and management information presented below (Table 1). 35/51 (69%) patients presented symptomatically as inpatients. Median overall survival (OS) of all patients was 3.4 (range 0.4-41.6) months. In PS 0/1 patients, those age <60 had OS of 7.4 (1.6-32.2) months compared with 13.4 (0.9-30.5) months in patients age >=60. Of those receiving best supportive care (BSC), OS was 1.7 (0.4-3.0) months. Patients receiving initial WBRT had OS of 3.5 (0.8-32.2) months, with those surviving >12 months also receiving  systemic therapy. Patients receiving surgery then WBRT had OS of 6.8 months. Patients with EGFR/ALK sensitising tumours had notably increased median OS of 16.5 months. 83.3% received tyrosine kinase inhibitors after initial WBRT. (Table presented) Conclusion: NSCLC patients presenting with synchronous brain metastases have overall poor prognoses regardless of treatment strategy, in keeping with previously published data. Selected patients, namely those with low volume intracranial disease and good PS suitable for neurosurgery/systemic therapy, or those with sensitising mutations had improved outcomes regardless of age. Our data reiterates that careful and timely patient selection is imperative prior to consideration of aggressive  local and systemic therapy or WBRT as opposed to BSC.